II-5-3-1.Good Cause for Failure to Follow Prescribed Treatment

SUBJECT

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Good Cause for Failure to Follow Prescribed Treatment

ISSUE

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Can the existence of a psychiatric impairment provide good cause for a claimant's failure to follow prescribed treatment?

DISCUSSION

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Note: The terms “good cause” as used in Social Security Ruling (SSR) 18-3p and “good reason” as used in 20 CFR 404.1530(b) and 416.930(b) should be considered synonymous.

Social Security Administration Regulations at 20 CFR 404.1530 and 416.930 and SSR 18-3p provide that a claimant will be found not disabled if he or she fails, without good cause, to follow prescribed treatment that can restore the ability to work. The regulations provide that we will consider a claimant's mental limitations, among other things, when determining if the claimant has good cause for not following prescribed treatment. While none of the examples provided in these sources mention or address psychiatric related reasons, except for incapacity causing the individual to be unable to understand the consequences of failing to follow treatment, the examples provided are not all-inclusive.

The existence of a psychiatric impairment may provide good cause for a claimant's failure to follow prescribed treatment. For example, we may be able to find good cause for failure to follow prescribed treatment in a case where the evidence shows that the claimant has paranoid schizophrenia with symptoms including a highly organized delusional system that leads him or her to believe that people are attempting to poison him or her and that medication prescribed by a physician is part of the poisoning “plot.”

INTERPRETATION

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If a claimant has a psychiatric impairment and his or her refusal to follow prescribed treatment is based on that impairment or that impairment and a combination of other impairments, the Appeals Council may find that such impairment is good cause for not following prescribed treatment.

APPLICATION

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The Appeals Council will apply this interpretation in all cases that come before it involving the same issue.

EFFECTIVE DATE

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CROSS-REFERENCE

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20 CFR 404.1530 and 416.930. HALLEX I-2-5-34.A.2.